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Medical Underwriting: What Is It and How Does It Work with Medicare?

Medicare Supplement plans are a great way to cover the gaps in Original Medicare, but the application process can be tricky. For many people, the most difficult part is answering the health questions. This part of the application process is called medical underwriting, and in many cases, carriers can use this information to determine if they’ll accept your application. Medical underwriting can be stressful if you don’t know what to expect, so we’ll answer some of the commonly asked questions about the process. 

What Happens During the Underwriting Process?

The underwriting process begins with you filling out your application. Each carrier may ask for different information, but in general, you can expect questions such as:

  • If you have specific health conditions on a list provided by the carrier
  • If you have any surgery or similar treatments scheduled
  • What medications you’re currently taking or have taken in the past few years

If you have any questions about whether something applies to you, you should always ask your agent for clarification. They’ll be able to help ensure that your application is accurate, which will speed up the process.  

Once an underwriter from the carrier has had the time to review your application, they may call you and ask some follow-up questions. If you miss their phone call, you should call back to complete your interview as soon as possible, because they won’t make their decision until they’ve spoken with you.  As long as your application is in order and you aren’t missing any paperwork, you should receive a notification of whether you’ve been accepted soon after your phone interview.

How Long is the Medical Underwriting Process?

Depending on the carrier and the time of year, the medical underwriting process can vary from a week to over a month. The Annual Enrollment Period (AEP) runs from October 15 – December 7, and it’s the only time of year that many people can apply for a Medicare Supplement plan. Because of this, carriers receive a high volume of applications, which can slow the underwriting process down. If you’re applying for coverage during AEP, you should apply as soon as it begins to ensure that you get approval in a timely fashion. Outside of AEP, most carriers are able to give their response within a week or two from when you submitted your application.

Can I Avoid the Underwriting Process?

Fortunately, there are a few scenarios in which you may be able to avoid medical underwriting.  This can be crucial if you have a serious health condition, because you may not be able to find a carrier that will accept you if they have a choice.

The following situations give you guaranteed issue rights, which means that you can be automatically approved for a Medicare Supplement plan.

You’re in Your Medigap Open Enrollment Period

Your Medigap Open Enrollment Period starts on the month that your Medicare Part B begins, and lasts for six months. For instance, if you start Medicare in July, your MOEP would end in December. Most carriers will also let you apply for the plan that you want six months before your Part B start date so that your Medicare Supplement plan will be active the moment your Medicare coverage begins. During this time, you’ll be able to sign up for a plan with any provider with no health questions. This is the only time most people can avoid underwriting, so it’s critical you take advantage of it.

Your State Has a Special Rule

 Some states have special rules that allow you to avoid medical underwriting. For example:

  • If you live in New York, Connecticut, Washington or Maine, you may be able to change your plan year-round without answering health-related questions
  •  If you live in California or Oregon, you can apply for a plan of equal or lesser value around your birthday
  • If you live in Missouri, you can apply for a plan of equal or lesser value around your policy’s anniversary date

You Lost Coverage Through No Fault of Your Own

The guidelines for this can vary, but if you lost coverage for a reason other than non-payment, you might be eligible for a guaranteed issue right. For instance, if you had a Medicare Advantage plan but moved out of the coverage network area, and were therefore dropped by your carrier, you would have a guaranteed issue right.   

Keep in mind that most of these guaranteed issue rights situations are time-sensitive. If you believe you fall into one of these categories, or will in the future, you should work with your agent as soon as possible to figure out your timeline.

The medical underwriting process is confusing for many people, and the wait to hear if you’ve been approved can be stressful. In order to have some peace of mind in the meantime, you can keep your current insurance active until you hear that you’ve been approved. This is a process that many people applying for Medicare Supplement insurance have to go through. While it may seem intimidating, you shouldn’t let it deter you from applying for the coverage that you want.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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